Three Deadly Scandals: A Sad Testament To Canadian Pathology;

"THREE MAJOR ONGOING SCANDALS IN ONTARIO, NEWFOUNDLAND AND LABRADOR AND NEW BRUNSWICK — WHICH HAVE COLLECTIVELY BEEN LINKED TO HUNDREDS OF DEATHS, TENS OF THOUSANDS OF SUSPECT TEST RESULTS AND DOZENS OF QUESTIONABLE IMPRISONMENTS — AND THEIR REQUISITE HIGH-PROFILE PUBLIC INQUIRIES, HAVE HIGHLIGHTED THE PATHOLOGY SYSTEM'S SERIOUS FAILINGS."

NATIONAL REVIEW OF MEDICINE STORY; SAM SOLOMON;

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The National Review Of Medicine - a publication for Canadian physicians - has published an article that echos this Blog's conclusion that the three on-going Inquiries - including the Goudge Inquiry which center's on Dr. Charles Smith's flawed work - signal a "crisis" in Canada's health care system.

The story, by Sam Solomon, appears today, under the heading "Canadian pathology mired in crisis" - and the sub-heading "Three deadly scandals expose gross failings in training, oversight...

Sir William Osler famously said, "As is our pathology so is our practice... what the pathologist thinks today, the physician does tomorrow," the story begins;

"If Dr Osler — a pathologist himself — was right, then Canada's entire medical system is in deep trouble, says Canadian Association of Pathologists president Dr Jagdish Butany," it continues;

""Over the last 20-plus years, we have not paid enough attention to laboratories and pathology and pathologists," he says.

"[The healthcare system has] relegated pathologists to the basement and given them that same priority."

The result of that chronic disregard is now becoming readily apparent: Canadian pathology is in crisis.

SYSTEMIC PROBLEMS

Three major ongoing scandals in Ontario, Newfoundland and Labrador and New Brunswick — which have collectively been linked to hundreds of deaths, tens of thousands of suspect test results and dozens of questionable imprisonments — and their requisite high-profile public inquiries, have highlighted the pathology system's serious failings.

As a result, an expert panel of leading medical authorities are now in the process of setting up a comprehensive review of the current deficiencies in pathology in Canada.

The details of the review haven't been finalized yet, says Royal College of Physicians and Surgeons of Canada CEO Dr Andrew Padmos, but the report will have another goal as well: to restore the public's severely shaken confidence.

The three scandals have done grievous damage to the profession's reputation.

"They've given us a black eye," Dr Butany admitted to the National Post last month as he and Dr Padmos dutifully denied a crisis exists and reassured reporters across the country that Canadian pathology is indeed trustworthy and can be repaired.

In conversation, however, cracks appeared in the veneer of their everything's-under-control exhortations.

After explaining that Canadian health human resources problems are having a particularly acute effect on the field of pathology — "We are concerned the problem is going to become worse and more widespread and we don't have in place an effective pan-Canadian action to stop it" — Dr Padmos quickly sought to quell any possible anxiety.

"Is it an absolute knockdown crisis? Of course not. What they need is some hope and some planning."

The shortage of pathologists and lab technologists is already putting pressure on the system.

"People are working too long hours, or past your threescore and ten, even," says Dr Butany, "so that makes for an increasing potential for mistakes. You don't have time to critically analyse previous work, to sit back and think."

But the real culprit in all three scandals appears to be a lackadaisical approach to quality assurance and training.

ONTARIO

Dr Charles Smith was once considered the epitome of expertise when it came to pediatric forensic pathology.

If a child died under suspicious circumstances in Ontario, all eyes turned to Dr Smith.

If Dr Smith served as an expert witness in a homicide case, people listened.
But that trust was misplaced.

Dr Smith is now at the centre of a public inquiry into the entire field of pediatric forensic pathology in the province.

Many child murder convictions that Dr Smith helped resolve have been thrown into question and the provincial Chief Coroner's office is now suggesting a total of 142 cases be reviewed.

Although Dr Smith made a dramatic apology to his victims at the inquiry, he wasn't actually on trial.

In fact, there's one thing he and his victims seem to be able to agree on: the balance of the blame should go to the pediatric forensic pathology system itself and the lack of oversight, training and quality assurance.

The inquiry's closing arguments wrapped up April 1. Justice Stephen Goudge is due to submit his final report and recommendations to the government by September 30.

NEWFOUNDLAND AND LABRADOR

In a strange twist of fate, the Ontario inquiry has come to a head at almost exactly the same time another inquiry, this one potentially just as broad as the Ontario one, is just getting underway in Newfoundland and Labrador.

This inquiry, headed by Justice Margaret Cameron, is looking at how 383 women were given incorrect estrogen and progesterone hormone receptor breast cancer test results (which determine whether the patient should receive tamoxifen) over an eight-year period from 1997 to 2005. Over a hundred of those women are now dead.

Again, the absence of standardized quality assurance — a problem that still persists today, says Dr Padmos — appears to have contributed significantly to the errors.

There have also been suggestions that a St John's lab may have misinterpreted the results of a now-outmoded method of immunohistochemical testing on biopsy tissue; a 2003 internal memo by pathologist Gershon Ejeckam called the lab's technique "unreliable and erratic" and said diagnoses based on those tests "will surely jeopardize patient care."

Amidst allegations of a politically motivated coverup, some have called for Health Minister Ross Wiseman's resignation. The inquiry's final report is due no later than July 30.

NEW BRUNSWICK

The New Brunswick investigation is slightly different from those in Ontario and Newfoundland in that it focuses more specifically on the work of one pathologist, Dr Rajgopal Menon of Miramichi, who was found to have a misdiagnosis rate of 3% and an incomplete diagnosis rate of 18% in a recent audit.

Another report released late last month said Dr Menon's "vision seemed to be failing," his hands were shaky and his work "fails to meet the current standards of surgical pathology."

Already, Dr Menon's lawyer, Mel Norton, has employed the same tactics that Dr Smith's have in Ontario, blaming the pathology system and the lack of oversight.

"[It's] too convenient just to aim the gun at one person," he told the Telegraph-Journal in February.

The government has ordered reviews of all 24,000 of Dr Menon's cases, from 1995 until 2007, and the RCMP has also been asked to consider charges of criminal negligence against Dr Menon.

Retired judge and former provincial Tory health minister Paul Creaghan, who is heading the inquiry, is due to submit his final report by August 22."

Harold Levy...hlevy15@gmail.com;